Quality Strategy

Ohio Medicaid’s Quality Strategy is central to guiding the agency’s ongoing mission to provide residents improved health outcomes through innovation. The Department of Medicaid is taking a population health approach to achieve this goal by grouping the Medicaid population into the following streams: Healthy Children and Adults, Women’s Health, Behavioral Health, and Chronic Conditions. Through innovative payment arrangements, quality improvement partnerships, and data each population stream’s desired health improvements will be achieved.

This document outlines the various ODM initiatives that are helping Ohio Medicaid to achieve its goals and continue to reform the health care landscape across Ohio.

Click here to access Quality Strategy

2020 Managed Care Report Card - Quality Performance

Quality Measures

CMS established an Initial Core Set of Measures for Adults in Medicaid in January 2012. Medicaid was awarded a grant to test and evaluate methods for collection and reporting results to CMS. This is Ohio’s report on selected measures from the initial core set of measures.

Medicaid managed care plans (MCPs) and MyCare Ohio Plans(MCOPs) are required to conduct annual surveys of member experience and satisfaction with care using an independent survey organization. Ohio Medicaid issues three Program-specific reports each year to provide a comprehensive analysis of the data. A high-level overview and key findings are contained in an Executive Summary Report, while detailed analyses and findings are presented in a Full Report. A Methodology Report offers a detailed description of the analytical methodology.

2019 MCP

2019 MCOP

2018 MCP

2018 MCOP

The annual external quality review technical report provides an evaluation of the accessibility, quality, and timeliness of services that Ohio’s Medicaid Managed Care Plans provided to their enrolled consumers. These reports were produced by ODM’s external quality review (EQR) organization, Island Peer Review Organization (IPRO), to comply with federal EQR requirements cited at 42 CFR 438.364.

SFY 2020 External Quality Review Technical Report

SFY 2019 External Quality Review Technical Report

Ohio Medicaid quality measures assess Managed Care Plan performance in key program areas (i.e., access, clinical quality, consumer satisfaction). The report shows results of these measures by managed care plan and statewide, grouped by population stream: Healthy Children, Healthy Adults, Women's Health, Behavioral Health, and Chronic Conditions. Individual managed care plan and statewide measure results are trended over a 5-year period and evaluated for comparison to national Medicaid benchmarks.

SFY 2019 HEDIS Aggregate Report for the Ohio Medicaid Managed Care Program

Medicaid managed care plans (MCPs) and MyCare Ohio Plans (MCOPs) are required to achieve and maintain health plan accreditation awarded by the National Committee for Quality Assurance (NCQA) for the Ohio Medicaid line of business. Each year, the Ohio Department of Medicaid evaluates Plans’ performance on this requirement. NCQA accreditation information, as well as current NCQA accreditation status for each contracted plan as of November 1st, are provided in the Health Plan Accreditation Status for Ohio’s Medicaid Managed Care Plans document.

In 2014, the Ohio Department of Medicaid administered a Quality of Life Survey to the Aged, Blind, or Disabled (ABD) and Covered Families and Children (CFC) child populations enrolled in managed care. The 2014 Ohio Medicaid Managed Care Quality of Life Survey shows results by managed care plan and statewide.

Pursuant to 42 CFR 438.340, CMS requires submission of the Ohio Department of Medicaid’s Managed Care Quality Strategy for Review. The Quality Strategy documents Ohio Medicaid’s approach to assessing and improving the quality of health care and services furnished by contracted managed care plans to their members.

The 2018 Ohio Department of Medicaid (ODM) Managed Care Quality Strategy